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G <br />IJTILITY PERMIT APPLICATION <br />CITY OF E�/ERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.everettwa.org <br />�� l ���;�� <br />PROJECT ADDRESS <br />� <br />Property <br />� � � <br />�� 'i �L ' L�1, <br />—o <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />City <br />State/Zip <br />c.��-�) <br />��� '` ��� <br />Phone <br />` � �.�C��: �; �l �c� c� d,?, �'!�' ;� � l 't,� �1.� � � (4�.",� `-�.�- �� �, � c� <br />Contractor y Mail Address City State/Zip Phone <br />i� �`�''3=�.��,, � t�� �� � i�, t�-- <br />WA State Contractor ticense Number (required) <br />Work to be done: <br />� Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />� <br />� Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />_____�._., <br />REVfSED 11/19/20>4 <br />{ 5 / f �� �� <br />City of Everett Business License Number {required) <br />Date <br />FEE <br />1` •�Do�� <br />PERMIT# <br />� I l� � r2- �� <br />